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The feasibility of automating audit and feedback for ART guideline adherence in Malawi.

Landis Lewis Z, Mello-Thoms C, Gadabu OJ, Gillespie EM, Douglas GP, Crowley RS - J Am Med Inform Assoc (2011)

Bottom Line: Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data.Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Center for Health Informatics for Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. zjl1@pitt.edu

ABSTRACT

Objective: To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi.

Materials and methods: We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups.

Results: We analyzed 423,831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled.

Discussion: It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.

Conclusion: A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

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Identification and assessment of recommendations.
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fig2: Identification and assessment of recommendations.

Mentions: Out of the 152 recommendations that were decidable and executable with measurable outcomes, 58 recommendations met the GLIA criteria for computability. From the 58 computable recommendations, 22 did not have associated EMR data resulting from HCWs' routine use of the system. Another 15 of the computable recommendations were not assessed for auditability due to complexity in representing temporal constraints. Of the 58 computable recommendations, 21 met the criteria for auditability (figure 2; totals for the recommendations not meeting GLIA criteria are not mutually exclusive and do not sum up to the n displayed in each box). Proof-of-concept feedback for the 21 auditable recommendations, using EMR data from the month of April, 2010, for one nurse and one clinical officer are displayed in table 2.


The feasibility of automating audit and feedback for ART guideline adherence in Malawi.

Landis Lewis Z, Mello-Thoms C, Gadabu OJ, Gillespie EM, Douglas GP, Crowley RS - J Am Med Inform Assoc (2011)

Identification and assessment of recommendations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3197989&req=5

fig2: Identification and assessment of recommendations.
Mentions: Out of the 152 recommendations that were decidable and executable with measurable outcomes, 58 recommendations met the GLIA criteria for computability. From the 58 computable recommendations, 22 did not have associated EMR data resulting from HCWs' routine use of the system. Another 15 of the computable recommendations were not assessed for auditability due to complexity in representing temporal constraints. Of the 58 computable recommendations, 21 met the criteria for auditability (figure 2; totals for the recommendations not meeting GLIA criteria are not mutually exclusive and do not sum up to the n displayed in each box). Proof-of-concept feedback for the 21 auditable recommendations, using EMR data from the month of April, 2010, for one nurse and one clinical officer are displayed in table 2.

Bottom Line: Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data.Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

View Article: PubMed Central - PubMed

Affiliation: Department of Biomedical Informatics, Center for Health Informatics for Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. zjl1@pitt.edu

ABSTRACT

Objective: To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi.

Materials and methods: We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups.

Results: We analyzed 423,831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled.

Discussion: It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance.

Conclusion: A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

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